An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement (original) (raw)
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Journal of Community Health
In the United States, low-income immigrant groups experience greater health disparities and worse health-related outcomes than Whites, including but not limited to higher rates of type 2 diabetes (T2DM). The prevention and adequate management of T2DM are, to a great extent, contingent on access to healthy food environments. This exploratory study examines “upstream” antecedent factors contributing to “downstream” health disparities, with a focus on disparities in the structural sources of T2DM risk, especially food environments. Our target group is Latino immigrants receiving services from a non-profit organization (NGO) in Northern California. Methods are mixed and data include focus groups and surveys of our target group, interviews to NGO staff members, and estimation of the thrifty food market basket in local grocery stores. We find that while participants identify T2DM as the greatest health problem in the community, access to healthy foods is severely restricted, geographically, culturally, and economically, with 100% of participants relying on formal or informal food assistance and local food stores offering limited variety of healthy foods and at unaffordable prices. While this article is empirical, its goal is primarily conceptual—to integrate empirical findings with the growing literature underscoring the sociopolitical context of the social determinants of health in general and of T2DM disparities in particular. We propose that interventions to reduce T2DM and comparable health disparities must incorporate a social justice perspective that guarantees a right to adequate food and other health-relevant environments, and concomitantly, a right to health.
Journal of Immigrant and Minority Health, 2000
An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.
The Limits of Self-Management: Community and Health Care System Barriers Among Latinos With Diabetes
Journal of Human Behavior in The Social Environment, 2010
Although numerous studies examine diabetes self-care, few regard ecological framework correlates such as community and institutional level factors as fundamental for understanding diabetes management for Latinos. This article addresses the dearth of research that exists regarding social contextual forces and diabetes management for Latinos. Given the scarcity of research on this topic, studies of non-Latino groups were reviewed to illustrate the importance of community and institutional influences on diabetes care. Consideration of fundamental correlates within the ecological framework may better discern the underlying rationale for inadequate diabetes self-management for individuals who live in impoverished communities.
International Journal of Environmental Research and Public Health, 2013
Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models.
Diabetes and health disparities: community-based approaches for racial and ethnic populations
2010
Translation, her work focused on developing community models for diabetes prevention and control programs in racial and ethnic communities in the continental U.S., in the Pacific Rim, along the U.S.-Mexico border, and for American Indian tribes in the Southwest. She has written extensively on community-based public health approaches to chronic disease prevention and control, the influence of culture and gender on health beliefs and behaviors, and the elimination of health disparities. Her principal research interests are focused on understanding the intersection of race, class, and gender in chronic disease risks, management, and prevention.
The Diabetes Educator, 2014
Purpose-This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. Methods-The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. Results-There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. Conclusions-Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program. Diabetes prevalence is estimated to include 25.8 million people of all ages in the United States, resulting in significant morbidity, mortality, and an economic burden of more than $245 billion annually. 1,2 As the fastest-growing minority population in the United States, Mexican Americans have one of the highest rates of diabetes: 11.8% versus 7.1% for non-Hispanic whites. 2 Even more concerning is the estimated 79 million adults in the United States who have prediabetes, most of whom will develop type 2 diabetes within 10 years. 3,4 Prevention of diabetes is clearly a public health imperative. The Diabetes Prevention Program (DPP) clearly demonstrated that intensive lifestyle modification delays or prevents the progression of prediabetes to diabetes, but it required costly resources to promote lifestyle change. 5 Therefore, it is not easily replicated in resource-limited community settings. Community-based diabetes prevention programs offered in convenient and familiar locations have the potential to reach underserved
Journal of Primary Care & Community Health
Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, an...
Journal of Behavioral Medicine, 2008
Diabetes is the sixth leading cause of death in the United States and it is now cited along with obesity as a global epidemic. Significant racial/ethnic disparities exist in the prevalence of diabetes within the US, with racial and ethnic minorities disproportionately affected by type 2 diabetes and its complications. Racial/ethnic and socioeconomic factors influence the development and course of diabetes at multiple levels, including genetic, individual, familial, community and national. From an ecodevelopmental perspective, cultural variables assessed at one level (e.g., family level dietary practices) may interact with other types of variables examined at other levels (e.g., the availability of healthy foods within a low-income neighborhood), thus prompting the need for a clear analysis of these systemic relationships as they may increase risks for disease. Therefore, the need exists for models that aid in "mapping out" these relationships. A more explicit conceptualization of such multilevel relationships would aid in the design of culturally relevant interventions that aim to maximize effectiveness when applied with Latinos and other racial/ethnic minority groups. This paper presents an expanded ecodevelopmental model intended to serve as a tool to aid in the design of multi-level diabetes prevention interventions for application with racial/ethnic minority populations. This discussion focuses primarily on risk factors and prevention intervention in Latino populations, although with implications for other racial/ethnic minority populations that are also at high risk for type 2 diabetes.
“It Feels Like Home When You Eat Rice and Beans”:Perspectives of Urban Latinos Living With Diabetes
Diabetes Spectrum, 2008
Background. Studies on Hispanics/Latinos with diabetes have largely focused on Mexican-American populations. This qualitative study explored psychosocial issues that affect diabetes self-management for Hispanic men and women of primarily Caribbean ancestry.Methods. Thirty-seven adults with diabetes in Bronx, N.Y., were recruited to seven focus groups, which were conducted in Spanish and English,audiotaped, transcribed, and subjected to qualitative analysis.Results. New themes emerged that are not well documented in the research literature for Hispanic/Latino populations with diabetes. These include the effect of diabetes on sexual health problems, perceptions about the link between depression and diabetes, intergenerational issues and their impact on participants' beliefs about diabetes, and perceptions of discrimination and discontinuity in health care.Conclusions. Findings suggest that perspectives among Hispanic/Latino populations about living with diabetes are diverse, and m...
The Diabetes educator
The purpose of this qualitative study was to understand how acculturation influences diabetes risk among urban immigrant Latinas (Hispanic women). Five focus groups were conducted with 26 urban immigrant Latinas who were at high clinical risk for developing diabetes. The focus group sessions were audiotaped and transcribed verbatim. The authors independently analyzed transcripts using an inductive method of open coding and established themes by consensus. All participants were foreign born and had low levels of acculturation. During the acculturation process, they noted changes in their lifestyle behaviors and the family context in which those behaviors are shaped. They reported that since living in the United States, their improved economic circumstances led to increased consumption of less healthy foods and beverages and a more sedentary lifestyle. They also described changing family roles and responsibilities, including working outside the home, which constrained healthy food cho...